Healthcare Provider Details

I. General information

NPI: 1558453118
Provider Name (Legal Business Name): CHRISTOPHER J WELLS POR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 CAPITAL MEDICAL BLVD STE. 100
TALLAHASSEE FL
32308-8405
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE. 400
TALLAHASSEE FL
32308-8405
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-8174
  • Fax: 850-877-5636
Mailing address:
  • Phone: 850-877-8174
  • Fax: 850-877-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPR0103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: